VITALITY ANTI-AGING CENTER AND MED SPA (NPI# 1285751008) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285751008 |
| Entity Type | Organization |
| Organization Name | VITALITY ANTI-AGING CENTER AND MED SPA |
| Practice Address |
74 8th St Se Suite 101 Hickory NC 28602-1130 |
| Mailing Address |
74 8th Street Se Suite 101 Hickory NC 28602-4942 |
| Practice Telephone | 8283221498 |
| Practice Fax Number | 8283222835 |
| Mailing Telephone | 8283221498 |
| Mailing Fax Number | 8283222835 |
| Enumeration Date | 2007-03-25 |
| Last Update Date | 2014-11-24 |
| Authorized Official Name | GRACE MCLAURIN (OWNER) |
| Authorized Official Telephone | 8283221498 |
| Authorized Official Credential | PA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
74 8TH ST SE SUITE 101 |
| City | HICKORY |
| State | NC |
| Zip Code | 28602-1130 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538243696 | Marcus Todd Hinceman | Psychiatry & Neurology | 74 8th St Se, Suite 101, Hickory, NC 28602-1130 | 2006-10-25 |
| 1598136848 | Wendy Chavez | Home Health | 74 8th St Se, Suite 225, Hickory, NC 28602-1130 | 2015-10-13 |
| 1851718555 | Health & Home Services, Inc. | Home Health | 74 8th St Se, Suite 225, Hickory, NC 28602-1130 | 2014-03-20 |
| 1245489517 | Health & Home Services, Inc. | Home Health | 74 8th St Se, Suite 225, Hickory, NC 28602 | 2008-09-11 |
| 1194893438 | Health & Home Services, Inc. | Home Health | 74 8th St Se, Suite 225, Hickory, NC 28602 | 2006-12-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063983286 | Ivan Ortega | Health Educator | 810 Fairgrove Church Road Se, Hickory, NC 28602 | 2018-12-16 |
| 1578078895 | Zachary Chad Greer | Physician Assistant | 1927 3rd Ave Ln Se, Hickory, NC 28602 | 2017-12-08 |
| 1952842015 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 2264 Us Highway 70 Se, Hickory, NC 28602 | 2017-03-09 |
| 1013456318 | Juanita Brown | Counselor | 306 4th St Sw, Hickory, NC 28602 | 2017-02-20 |
| 1639616725 | Francisca Blanco | Clinic/Center | 5276 0lde School Dr, Hickory, NC 28602 | 2017-01-26 |
| 1982155263 | Livanta Medical Center | Physician Assistant | 2105 Catawba Valley Blvd Se, Hickory, NC 28602 | 2016-10-20 |
| 1225588817 | Melike Demirozu | Social Worker | 738 4th St. Sw, Hickory, NC 28602 | 2016-10-07 |
| 1528411592 | April Prout | Social Worker | 1053 13th St Se, Hickory, NC 28602 | 2016-07-14 |
| 1457706921 | Maitry Parikh | Dentist | 2535 Us Highway 70 Se Ste 112, Hickory, NC 28602 | 2016-05-03 |
| 1245614510 | Doran Stilwell | Physical Therapy Assistant | 4161 South Fork Avenue, Hickory, NC 28602 | 2015-07-16 |
| Find all providers in zip 28602 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649705278 | Jonathan Gross | Physician Assistant | 3169 12th Ave Se, Hickory, NC 28602-9666 | 2017-04-20 |
| 1982155263 | Livanta Medical Center | Physician Assistant | 2105 Catawba Valley Blvd Se, Hickory, NC 28602 | 2016-10-20 |
| 1548462161 | Richard William Poole | Physician Assistant | 2280 Us Highway 70 Se, Hickory, NC 28602-5164 | 2007-06-05 |
| 1831259084 | Jimmy Edward Johnson | Physician Assistant | Mountain View Family Practice, 1940 Briarwood Drive, Hickory, NC 28602-5497 | 2006-12-11 |
| 1992754972 | Sonal Mistri Lane | Physician Assistant | 220 18th St Circle Se, Hickory, NC 28602 | 2006-05-08 |
| 1366441149 | Grace Mclaurin | Physician Assistant | 74 8th Street Se, Suite 101, Hickory, NC 28602-4942 | 2005-07-14 |
| 1356340137 | Denise Curtis | Physician Assistant | 716 Lenoir Rhyne Blvd Se, Hickory, NC 28602-4134 | 2005-07-14 |
| 1235622515 | Catherine Leah Nelson | Physician Assistant | 2810 16th St Ne, Hickory, NC 28601 | 2018-06-11 |
| 1568909042 | James Lisowski | Physician Assistant | 810 Fairgrove Church Rd, Hickory, NC 28602-9617 | 2017-01-23 |
| 1376909325 | Brian John Devlin | Physician Assistant | 30 13th Ave Nw, Hickory, NC 28601-3765 | 2016-01-06 |
| Find all providers in HICKORY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.